The Most Common Rowing Injuries That Occur and How to Prevent Them
– January 2015 –
Rowing is becoming an increasingly popular activity and accompanying its’ intensive training is a group of common injuries that rowers present with in addition to other non-specific sport injuries and complaints. The majority of rowing complaints are overuse injuries or due to equipment problems. Acute causes of injury are rare, however any abrupt change in rowing volume or training technique, increased training intensity and level or change of boat can exacerbate, expose or predispose the rower to injury. Particular stroke techniques, physiological conditioning through high pressure and low cadence training and off water heavy weight training all also increase the risk of developing overuse injuries1.
According to the available literature, lower back pain is the most common complaint in rowers. The causes of lower back pain in rowers is multifactorial; it includes the large forces involved with rowing, the high percentage of time spent in lumbar flexion during the rowing cycle, the time of day when much of rowing occurs, hypermobility of the lumbar spine due to fatigued and stretched muscles that support the spine and short or stiff hamstrings which decrease pelvic motion causing overflexion of the spine. The time of day that rowing occurs is significant because lumbar discs absorb fluid overnight causing increased bending stressors on the spine compared to later in the day when the discs have less fluid. Much of rowing training however occurs in the morning which is when the spine is most vulnerable to injury. As such, it is recommended to warm up with repeated flexion and extension movements without load at a slow speed for at least 60 seconds. This can be achieved by sitting in a position to imitate rowing posture in a boat and gradually increasing the range of motion of a rowing stroke without any load. This allows the lumbar spine to warm up and prepare rather than placing large forces on the already vulnerable early morning vulnerable spine without preparation. Stretching of the hamstrings routinely is also recommended and short or stiffness of the hamstrings decrease pelvic motion which further predisposes rowers to overflexion of the spine2. The combination of excessive hyperflexion and twisting during the rowing stroke, the repetitive nature of rowing training and large forces create the potential for injury to the lumbar spine structures, making rowers vulnerable to conditions such as spondylosis, sacroiliac joint dysfunction and disc herniation,3. As such particular focus to timely warm up flexion and extension without load, proper stroke mechanism and stretching is important to minimise mechanical stress. Specific muscle activity of the lateral abdominal muscles during the rowing stroke has been shown to be increase lumbar stability, so training of these muscles can also be beneficial.
Thoracic injuries are another subset of injuries specific to rowers and include rib stress fractures, rib stress reaction, costochondritis, costovertebral joint subluxation and intercostals muscle strains. Rib fractures in elite rowers at the AIS accounted for 14% of all rowing injuries from 2009-2011 and caused 24% of lost training time4. The exact cause behind rib fractures in rowing is unknown but there are many theories postulated. A study in Sweden which compared rowers with rib stress fractures compared to rowers without rib stress fractures demonstrated that the rib fracture rowers had greater force of contraction in their upper body muscles during the drive phase of the stroke compared to the rowers without fractures5. This finding supports the theory that rib stress fractures in rowing is due to repetitive rib cage compression. The same study also suggests that training with ergometer in slides may decrease the risk of rib fractures as there is less force production per stroke without compromising training intensity and performance compared to training on water. The other common aforementioned rib injuries are also postulated to be due to similar overuse aetiology.
Shoulder pain is common among rowers and can be attributed to overuse, upper body tension or poor technique. Knee pain is often associated with abnormal patella tracking. The abnormal tracking of the patella causes irritation to the surrounding structures of the knee which is continually aggravated by the repetitive flexion and extension motion of the knee during each rowing stroke2. Iliotibial band syndrome, which is another overuse injury, causes lateral knee pain due to local irritation. After the initial inflammatory process is relieved by rest and ice, stretching of the iliotibial band, massage, dry needling and muscle re-education particularly to the vastus medialus obliqus are all beneficial6.
There are also wrist and forearm injuries associated with rowing again attributed to overuse. Exertional compartment syndrome can occur which is due to increased pressure in sections of the forearm due to training increasing the bulk of particular muscles in sections of the arm. Nerve impingement can also occur due to this and can present as carpal tunnel syndrome with pins and needles in the hands. Tensynovitis of the wrist extensors can also occur, due to repetitive force and irritation during the drive phase of the rowing stroke2.
Lastly, dermatological complaints such as blisters and abrasions are also common, again due to the repetitive nature of rowing training. This can be prevented with the use of well fitted equipment and good training technique. It is also important as rowing often involves a lot of on water training to be mindful of the UV exposure.
As discussed, the majority of rowing injuries can be attributed to the repetitive nature of the sport. In order to prevent them from occurring in the first place proper stroke mechanism to reduce mechanical stress is important. Stressful weight training which is often performed is not recommended for rowers. Stretching, paying particular attention to problem areas is beneficial. The use of good equipment and a well organised training regime are also important to avoid unnecessary injury1.
Luke at South Yarra Sports Medicine has extensive experience and much success in the management and prevention of rowing injuries. Please do not hesitate to contact SYSM if you have any rowing-associated injuries for further information or to arrange a consult with Luke.
Dr Luke Nichols, Ebony Dunne
Like us on Facebook for more health performance tips and behind the scenes action from SYSSM.
- Pelham, TW. Technique and training induced injuries in elite rowers. ISBS Conference Preceedings Archive.
- Reid, P. Factors contributing to low back pain in rowers. Br J Sports Med. 2000;34:321-325.
- Rumball, JS. Rowing Injuries. Sports Med. 2005;35(6):537-55.
- Rowing Australia: AIS National Rowing Centre of Excellence http://www.rowingaustralia.com.au/docs/chest-wall-pain-guidelines_2011.pdf
- Vinther, A. Rib stress fractures in elite rowers. Department of Health Sciences, Faculty of Medicine, Lund University, Sweden 2008.
- Brukner P. Brukner & Khan’s Clinical Sports Medicine . Fourth Edition. Australia: McGraw Hill; 2012.
DR. LUKE NICHOLS
Luke Nichols holds a Masters of Clinical Chiropractic with Distinction, and is the founder and principal chiropractor of SYSSM, with other 9 years of clinical experience. Luke is a keen athlete, and has worked with many elite sporting teams in a professional capacity, including the Australian Olympic Rowing Team.